Chemotherapy Only in Early Stage Hodgkin Lymphoma: More Relapses but the Same Survival – What to Do?
Limited-stage Hodgkin lymphoma can almost always be cured with combined-modality chemotherapy plus involved-field or involved-nodal radiation, at the cost of exposing all patients – many unnecessarily – to radiation. Large prospective randomized clinical trials, including a total of over 1,200 patients, indicate that at least 95 % of patients with limited-extent Hodgkin lymphoma are cured. The data also demonstrate that more than 80 % of patients treated with two to three cycles of ABVD chemotherapy reach a positron emission tomography (PET)-negative state. Such patients need only one to two additional cycles of ABVD to reach an anticipated 95 % cure rate. The remaining 20 % of patients, with a positive PET, should be given radiation to reach the same 95 % cure rate. The above approach leads to the same overall cure rate as one comprising combined chemotherapy and radiation, but avoids radiation for 80 % of patients. Treatment outcome for limited-stage Hodgkin lymphoma is best optimized – considering cost, inconvenience, toxicity, and efficacy – using interim PET assessment to minimize exposure to radiation.